Psychometric assessment Premnath 28 Feb 2013

Psychometric assessment and its implications in mental health nursing....

1. Psychometric assessment Presented by Premnath R Govt . CON, Kottayam

2. PSYCHOMETRIC ASSESSMENT “ Psyche ” - mind “ Metron ” - to measure Chan dynasty - 1000 B C East India Company - 1832 A D British model of Chinese testing system - 1855 A D American Civil Service Commission – 1883 A D

3. PSYCHOMETRIC ASSESSMENT Two streams of thoughts Measurement of individual differences (Darwin, Galton, Cattell ) Psychophysical measurements (Herbart, Weber, Fechner, Wundt) Experimental psychology and standardized testing

4. PSYCHOMETRIC ASSESSMENT Definition Psychometrics is defined as the branch of psychology dealing with measurable factors, but also as the occult power of defining the priorities of things by mere contact. (Chambers Twentieth Century Dictionary)

5. PSYCHOMETRIC ASSESSMENT Definition ‘A psychological test is any procedure on the basis of which inferences are made concerning a person's capacity, propensity or liability to act, react, experience, or to structure or order thought or behavior in particular ways.’ (The British Psychological Society)  

6. PSYCHOMETRIC ASSESSMENT Definition   Psychological tests are written, visual, or verbal evaluations administered to assess the cognitive and emotional functioning of children and adults. American Psychological Association (APA) A psychological test is an objective and standardized measure of an individual's mental and/or behavioral characteristics. A psychological test is an instrument designed to measure unobserved constructs, also known as latent variables. (Wikipedia)

7. CHARACTERISTICS OF A GOOD PSYCHOLOGICAL TEST Reliability. Validity. Norms Uniform Objective Interpretable Standardization Objectivity

8. DEVELOPMENT OF A PSYCHOLOGICAL TEST Analysis of the situation Tentative selection of test items Development of standardized procedures Administration of test to a representative group Final selection of the test items Evaluation of the final test -

9. Types of tests Depending upon time limit: Speed test and power test. e.g. Kaufman Assessment battery for children Depending upon number of individuals: Group test and Individual test Depending upon language: Verbal and Non- verbal test. Depending upon method: Paper -pencil and performance test . Computed assisted tests:

10. Depending upon what is measured: Intelligence tests, Aptitude tests, Achievement tests, Personality tests. Occupational tests: Interest tests: Aptitude tests: General Aptitude Test Battery (GATB), Differential Aptitude Tests(DAT)

11. Achievement & ability tests STANFORD-BINET INTELLIGENCE SCALES:- Devised in 1916 by Stanford psychologist Lewis Terman .

12. STANFORD-BINET INTELLIGENCE SCALES Consisting of questions and short tasks arranged from easy to difficult, the Stanford- Binet scale measures a wide variety of verbal and nonverbal skills. Its fifteen tests are divided into verbal reasoning quantitative reasoning abstract/visual reasoning short-term memory

13. Binet Scale of Human Intelligence IQ Over 140 Genius or Near-Genius/ Gifted 120 – 139 Very Superior 110 – 119 Superior 90 – 109 Average or Normal 80 – 89 Dull Normal 70 – 79 Borderline Deficiency/Mild 50 – 69 Moron /Moderate 20 – 49 Imbecile /Severe Below 20 Idiot/ Profound

14. WECHSLER INTELLIGENCE SCALES:- David "Wex" Wechsler  (January 12, 1896 – May 2, 1981)

15. WECHSLER INTELLIGENCE SCALES Include both verbal and non- verbal tests Verbal tests include, Vocabulary Information Comprehension Arithmetic Similarities Digit span

16. WECHSLER INTELLIGENCE SCALES Performance tests include, Digit symbols Picture completion Block design Picture arrangement Object assembly(jigsaw)

17. Verbal Intelligence test Information : A persons level of general knowledge Comprehension : How well you can understand questions and grasp concepts. Arithmetic : A persons mathematical abilities. Similarities : Measures abstract thought. Digit Span : Measures attention span. Vocabulary : How many word meanings you know.

18. Performance Intelligence Test Digit Symbol : Mental flexibility with random symbols. Picture Completion : Ability to notice differences between two similar pictures. Block Design : Mentally construct printed designs in your head. Picture Arrangement : Arrange pictures in a logical order. Object Assembly : Place the correct part in relationship to a whole.

19. WECHSLER INTELLIGENCE SCALES TYPES The Wechsler Preschool and Primary Scales of Intelligence (WPPSI) The Wechsler Intelligence Scale for Children (WISC) Wechsler Adult Intelligence Scale (WAIS)

20. WAIS-R Testing kit Testing Booklet Story Cards Puzzle Pieces Block Design

21. WAIS-R Block Design

22. Kaufman Assessment Battery for children Incorporate ideas from cognitive psychology and neuropsychology It consists of 16 subtests ,some for older and some for younger children (tests that measure the school experiences more directly such as naming pictures of well-known places and objects) .

23. Kaufman Assessment Battery for children The test fall into several categories: Sequential processing , such as remembering a series of digits or hand movements; Simultaneous processing , such as arranging a series of related pictures in the correct order;

24. The Binet Kamat Test of intelligence The test consist of items at each age level vocabulary Language development compression sentence building similarities and differences analogies sentence repetition auditory perception social reasoning visual-motor co-ordination ability.

25. The Binet Kamat Test of intelligence It is useful to evaluate Basal age - the ability to pass all the test items at the particular age. Terminal age - the inability to pass any of the items on a particular age level. The Binet Kamat Test of Intelligence - the Hindi version can be used for children well versed with the Hindi language

26. Ravens progressive matrices Developed by John C Raven in 1936. The test consists of 50 designs each of which has a cut out segment . The subject is shown the 6-8 cut out alternative pieces and is asked to indicate what to be put in the matrix.

27. Ravens progressive matrices Matrices are available in three different forms for participants of different ability . Standard Progressive Matrices: Colored Progressive Matrices: Advanced Progressive Matrices:

28. RAVEN’ S MATRICES

29. RAVEN’S MATRICES

30. PERSONALITY TESTS Personality tests and inventories evaluate the thoughts, emotions, attitudes, and behavioral traits that comprise personality. The results of these tests determine an individual's personality strengths and weaknesses, and may identify certain disturbances in personality, or psychopathology

31. PERSONALITY INVENTORY Minnesota Multiphasic Personality Inventory Millon Clinical Multiaxial Inventory (MCMI )   The California Psychological Inventory (CPI) Sixteen Personality Factor Questionnaire (or 16PF ) The Eyesenck Personality Inventory

32. PROJECTIVE TECHNIQUES Rorschach test :- Thematic Apperception Test (TAT) Sentence completion test Create drawings (Draw a person test) or complete a story . NEUROPSYCHOLOGICAL ASSESSMENT RATING SCALES

33. Minnesota Multiphasic Personality Inventory Developed in the late 1930’s by psychologist Starke R. Hathaway and psychiatrist J.C. McKinley at the University of Minnesota . The most widely researched and clinically used of all personality tests Developed to identify emotional disorders This is one of the most frequently used personality tests in mental health.

34. Minnesota Multiphasic Personality Inventory The test is used by trained professionals to assist in identifying personality structure and psychopathology. consists of 567 statements that the test taker has to mark as “true,” “false,” or “cannot say.” Answers are scored according to how they correspond with those given by persons with various psychological disorders, including depression, hysteria, paranoia, psychopathic deviancy, and schizophrenia.

35. Minnesota Multiphasic Personality Inventory The MMPI is copyrighted by the University of Minnesota. It is appropriate for use with adults 18 and over . The current MMPI-2 has 567 items , all true-or-false format, and usually takes between 1 and 2 hours to complete depending on reading level.

36. Minnesota Multiphasic Personality Inventory The MMPI-2 is most commonly used by mental health professionals to assess and diagnose mental illness. The MMPI-2 has been utilized in other fields outside of clinical psychology. The test is often used in legal cases, including criminal defense and custody disputes.

37. Millon Clinical Multiaxial Inventory (MCMI ) It has been designed for adults (18 years and older) who have a minimum of an eighth-grade reading level. The MCMI is one of the few self-report tests that focus on personality disorders along with symptoms that are associated with these disorders.

38. Millon Clinical Multiaxial Inventory (MCMI ) The current version, the MCMI-III, is composed of 175 items that are scored to produce 28 scales divided into following categories Modifying Indices, Clinical Personality Patterns, Severe Personality Pathology Clinical Syndromes Severe Syndromes

39. The California Psychological Inventory (CPI) It assesses Traits (including dominance, responsibility, self-acceptance) Socialization Traits relevant to academic achievement. Personality Research Form (PRF) The Neuroticism Extroversion Openness Personality Inventory, Revised (NEO-PIR)

40. Sixteen Personality Factor Questionnaire (or 16PF) Over several decades of research by Raymond B. Cattell and his colleagues. Big Five secondary traits , which have become popularized by other authors in recent years.

41. THE EYESENCK PERSONALITY INVENTORY Short questionnaire which can be completed in 10 to 20 minutes. It assesses two dimensions of personality: Introversion versus Extroversion, and Neuroticism versus Emotional stability. The EPI includes a subset of questions that comprises a Social Desirability Scale (Lie Scale):

42. PROJECTIVE TECHNIQUES Projective techniques involve asking subjects to interpret or fill in visual stimuli, complete sentences, or report what associations particular words bring to mind. Because of the leeway provided by the tests, subjects project their own personalities onto the stimulus, often revealing personal conflicts, motivations, coping styles, and other characteristics.

43. Rorschach test Hermann Rorschach  (8 November 1884 – 1 April 1922)

44. Rorschach test Created in the 1920s by Swiss psychologist Hermann Rorschach (1884-1922). It consists of a series of 10 cards, each containing a complicated inkblot. Some are in black and white, some in color. Subjects are asked to describe what they see in each card.

45. Rorschach test Test scores are based on several parameters: 1) what part of the blot a person focuses on 2) what particular details determine the response; 3) the content of the responses (what objects, persons, or situations they involve); 4) the frequency with which a particular response has been given by previous test takers

46. Rorschach test

47. Thematic Apperception Test (TAT) Introduced at Harvard University in 1935 by Henry Murray. Test takers look at a series of up to 20 pictures of people in a variety of recognizable settings and construct a story about what is happening in each one. They are asked to describe not only what is happening at the moment shown in the picture but also what events led up to the present situation and what the characters are thinking and feeling.

48. Thematic Apperception Test (TAT) Its adherents assert that the TAT taps a subject's unconscious to reveal repressed aspects of personality , motives and needs for achievement, power and intimacy, and problem-solving abilities.

49. Thematic Apperception Test (TAT) The subject is asked to tell as dramatic a story as they can for each picture presented, including the following: what has led up to the event shown what is happening at the moment what the characters are feeling and thinking what the outcome of the story was

50. TAT PROCEDURE

51. Some TAT cards

52. Thematic Apperception Test (TAT ) There are 31 picture cards in the standard form of the TAT . Some of the cards show male figures, some female, some both male and female figures, some of ambiguous gender, some adults, some children, and some show no human figures at all. One card is completely blank

53. Thematic Apperception Test (TAT) USES OF TAT Individual assessments for employment in fields requiring a high degree such as law enforcement, military leadership positions. For diagnosis in order to match psychotherapy best suited to patients personalities. Forensic purposes in evaluating the motivations and general attitudes of persons accused of violent crimes. Research into specific aspects of human personality, most often needs for achievement, fears of failure, hostility.

54. sentence completion test Specifically for children or adolescents. Subjects are asked to complete sentences with such open-ended beginnings as “I wish . . .” or “My mother . . .” Same sentence beginnings are shown to different test takers. There are no norms for comparing their answers to those of previous subjects.

55. CREATE DRAWINGS ( Draw a person test ) complete a story .

56. NEUROPSYCHOLOGICAL ASSESSMENT Luria- Nebraska battery Halsted- Reitan battery Michigan neuropsychological battery Shipley Institute of Living Scale NIMHANS neuropsychological battery.

57. NEUROPSYCHOLOGICAL ASSESSMENT Assessment of the neurological deficit Predicts the possible organic psychopathology Identification of intact neurological functioning help in the process of neuro -rehabilitation (Cognitive retraining) Evaluation and comparison of various treatment options and its perceived efficacy Progressive evaluation and formulation of differential diagnosis Developmental progression of the milestones Tackling the mental developmental delay, and taking necessary actions on time

58. RATING SCALES Rating scales are instruments used to assess the magnitude or severity of a psychological construct or disorder. Rating scales aid in research and clinical practice such data are important for evaluation, decision making, documentation and/or analysis.

59. Common rating scales in psychiatry:- For the assessment of general mental health: Golberg general health questionnaire(GHQ) Subjective wellbeing inventory (SWBI) For the assessment of anxiety :- Hamilton anxiety rating scale (HARC), Covi anxiety scale

60. Common rating scales in psychiatry:- For the assessment of depression :- Hamilton depression rating scale (HDRS), Beck depression Inventory(BDI) For the assessment of mania :- Young’s mania rating scale, Bech - Rafaelson mania scale

61. Common rating scales in psychiatry:- For the assessment of schizophrenia :- Brief psychiatric rating scale, Scale for assessment of positive symptoms and scale for assessment of negative symptoms.

62. PSYCHOLOGICAL TESTS USED IN INDIAN SCENARIO   The Bayley Scales of Infant Development has been standardized on Indian children The Pandey's Cognitive Development test for the pre-school child is a standardized test, Conceptual skills Information Comprehension Visual Perception Memory Object vocabulary

63. APPLICATIONS OF PSYCHOLOGICAL TESTS IN PSYCHIATRY Assist in diagnosis:- Assist in the formulation of psychopathology and in the identification of areas of stress. Determine the nature of the deficits. Assess the severity of psychopathology and response of treatment. To assess general characteristics of the individual. Easy to get information and is more scientifically consistent. Used for forensic evaluation, family court issues, or criminal charges. Assess level of functioning or disability.

64. LIMITATIONS OF PSYCHOLOGICAL TESTING PROGRAMS  Uncritical use Faking Attitudes toward testing Effects of negative attitudes   Ethical issues Test users Test security Test interpretation Test publication Privacy issues

65. NURSE’S ROLE IN PSYCHOLOGICAL TESTS Should have knowledge about all the psychological tests. Clarify the patient’s and relatives’ doubts regarding the psychological tests they have to undergo. Nurses should have good rapport with the patients and family members.

66. NURSE’S ROLE IN PSYCHOLOGICAL TESTS The nurse should reassure the patient about the safety of the tests and the confidentiality of the observations of the psychologist. The nurse observes the patient’s behavior and the changes, which occur once the therapy is commenced. The nurse observes, informs and records these changes in patient’s chart.

67. NURSE’S ROLE IN PSYCHOLOGICAL TESTS A nurse who is knowledgeable and skilled is an empowered nurse who is able to function at par with other team members and thus further build up the nursing images in the public eye. The nurse can also interrupt the findings of various tests and then plan the nursing care accordingly.